A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients
Open accessAbstract
Background Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging. Objective This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse. Methods Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes. Results Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR=3.6 [95% CI: 0.9-18.0], p=0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm. Conclusions This pilot randomized trial addressing do…
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Cardiac arrest outcome is multifactorial and may include long-term changes in functional, emotional, physical, cognitive and social domains, all associated with health-related quality of life.
“Today, it is understood that cardiac arrest outcome is multifactorial and may include long-term changes in functional, emotional, physical, cognitive and social domains, all associated with health-related quality of life. 283”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [283]
Educational CPR videos and structured patient-centred interviews can be helpful in decision making, with more patients likely to forgo CPR and focus on comfort.
“Educational CPR videos and structured patient-centred interviews can be helpful in decision making with more patients likely to forgo CPR and focus on comfort. 4,45,70,273,274”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [274]
Traditionally, cardiac arrest outcomes have been clinician-reported, and often dichotomised as good or poor.
“Traditionally, cardiac arrest outcomes have been clinician-reported, and often dichotomised as good or poor. 283”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [283]
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European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
Mentzelopoulos, S. D., Couper, K., Voorde, P. V. D., Druwé, P., Blom, M., Perkins, G. D., Lulic, I., Djakow, J., Raffay, V., Lilja, G., et al. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.02.017 · Cited by 246 · see citing works
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Lin, C.-P., Evans, C. J., Koffman, J., Armes, J., Murtagh, F. E. M., & Harding, R. (2019) · Palliative Medicine · doi:10.1177/0269216318809582 · Cited by 77 · see citing works
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- Authors
- Epstein, A. S., Volandes, A. E., Chen, L. Y., Gary, K. A., Li, Y., Agre, P., Levin, T. T., Reidy, D. L., Meng, R. D., Segal, N. H., Yu, K. H., Abou-Alfa, G. K., Janjigian, Y. Y., Kelsen, D. P., & O'Reilly, E. M.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Massachusetts General Hospital (US)
- Memorial Sloan-Kettering Cancer Center
- Corresponding author
- Epstein, Andrew S.
- ORCID
- Venue
- Journal of Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2013-06-01
- Volume
- 16
- Issue
- 6
- Pages
- 623-631
- ISSN
- 1096-6218 (ISSN-L)
- 1557-7740
- PMC
- PMC5586157
- OpenAlex
- W2090869775
- Cited by
- 91
- References
- 1
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 4 · 2022: 12 · 2021: 6 · 2020: 12 · 2019: 6 · 2018: 8 · 2017: 7 · 2016: 8 · 2015: 14 · 2014: 4 · 2013: 1
- FWCI
- 9.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Palliative Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- cardiopulmonary resuscitation, advance care planning, advance directives, educational videos, pancreatic cancer, hepatobiliary cancer, end-of-life decisions, hospice use, patient education
- MeSH terms
- Adult, Aged, Aged, 80 and over, Biliary Tract Neoplasms, Female, Humans, Liver Neoplasms, Male, Middle Aged, Pancreatic Neoplasms, Patient Education as Topic, Pilot Projects, Video Recording, Confidence Intervals, Odds Ratio, Cardiopulmonary Resuscitation, Disease Progression, Advance Care Planning
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